Clinician-Rated Dimensions of Psychosis Symptom Severity

Name:_________________________ Ages:______ Sex:[ ] Male [ ] FemaleDate:___________

Instructions: Based on all information you have on individual and using your clinical judgement, plaese rate (w/
checkmart) the presence and severity of the following symptoms as experinced by the individual in the past seven (7) days.

Domain Hallucination

0
Not present

1
Equivocal (severity or duration not sufficient to be considered psychosis) Equivocal (severity or duration not sufficient to be considered psychosis) Equivocal (severity or duration not sufficient to be considered disorganization) Equivocal (severity or duration not sufficient to be considered abnormal psycomotor behaviour) Equivocal decrease in facial expressivity, prosody, gestures or selfiritiated behaviour

2
Present but mild (little pressure to respond to voice, or is somewhere bothered by voice)

3
Present and moderatec(some pressure to respond to voices, or is somewhat bothered by voices) Present and moderatec(some pressure toact upon beliefs or is somewhat bothered by beliefs) Present and moderatec(speech often difficult to follow)

4
Present and severe (severe pressure to respond to voices, or is very bothered by voices) Present and severe (severe pressure to act upon beliefs or is very bothered by beliefs) Present and severe (speech almost impossible to follow)

Score

Delution

Not present

Present but mild (little pressure to act upon delusional beliefs, not very bothered by belief)

Disorganized speech

Not present

Present but mild (some difficulty following speech)

Abnormal Psycomotoric behaviour

Not present

Present but mild (occasional abnormal or bizzare motor behaviour or catatonia)

Present and moderatec(freque nt abnormal or bizzare motor behaviour or catatonia)

Present and severe (abnormal or bizzare motor behaviour or catatonia almost constant)

Negative symptom ( restricted emotional expression or avolition

Not present

Present but mild decrease in facial expressivity,prosod y, gestures or selfiritiated behaviour

Present and moderatedecreas

e in facial expressivity, prosody, gestures or self-iritiated behaviour

Present and severedecrease in facial expressivity, prosody, gestures or self-iritiated behaviour

Domain Impaired cognition

0
Not present

1
Equivocal (cognitive function not clearly outside the range expected for age or SE; i. e., within 0,5 SD of mean Equivocal

2
Present but mild (some reduction in cognitive function; below expected for age or SES, 0,5-1 SD of mean)

3
Present and moderate (clearly reduction in cognitive function; below expected for age or SES, 1-2 SD of mean)

4
Present and severe (severe reduction in cognitive function; below expected for age or SES, >2 SD of mean) Present and

Score

Depression

Not present

Present but mild

Present and

(occasionally feels sad, down, depressed, or hopeless; concerned about having failed someone or at something but not preoccupied)

Mania

Not present

Equivocal (occational elevated, expansive, or irritable mood or some restlessness)

(frequent periods of feels sad, down, moderately depressed, or hopeless; concerned about having failed someone or at something but not preoccupied) Present but mild (frequent periods of somewhat elevated, expansive, or irritable mood or restlessness)

moderate (frequent periods of deep depression, or hopelessness; preoccupation with guilt, having done wrong)

Present and moderate (frequent periods of extensively elevated, expansive, or irritable mood or restlessness)

severe (deeply depressed, or hopeless daily; delucional with guilt or unreasonable self-reproach grossly out of proportion to circumtance) Present and severe (daily and extensively elevated, expansive, or irritable mood or restlessness)

Clinician-Rated Dimensions of Psychosis Symptom Severity

Name:_________________________ Ages:______ Sex:[ ] Male [ ] FemaleDate:___________
Instructions: Based on all information you have on individual and using your clinical judgement, plaese rate (w/
checkmart) the presence and severity of the following symptoms as experinced by the individual in the past seven (7) days.

Domain Hallucination

0
Not present

1
Equivocal (severity or duration not sufficient to be considered psychosis)

2
Present but mild (little pressure to respond to voice, or is somewhere bothered by voice)

3
Present and moderatec(s ome pressure to respond to voices, or is somewhat bothered by

4
Present and severe (severe pressure to respond to voices, or is very bothered by

Score

voices)

voices)

Delution

Not present

Equivocal (severity or duration not sufficient to be considered psychosis) Equivocal (severity or duration not sufficient to be considered disorganiz ation) Equivocal (severity or duration not sufficient to be considered abnormal psycomoto r behaviour) Equivocal decrease in facial expressivit y, prosody, gestures or selfiritiated behaviour

Present but mild (little pressure to act upon delusional beliefs, not very bothered by belief) Present but mild (some difficulty following speech)

Disorganized speech

Not present

Present and moderatec(s ome pressure toact upon beliefs or is somewhat bothered by beliefs) Present and moderatec(s peech often difficult to follow)

Present and severe (severe pressure to act upon beliefs or is very bothered by beliefs) Present and severe (speech almost impossible to follow)

Abnormal Psycomotoric behaviour

Not present

Present but mild (occasional abnormal or bizzare motor behaviour or catatonia)

Present and moderatec(fr equent abnormal or bizzare motor behaviour or catatonia)

Present and severe (abnormal or bizzare motor behaviour or catatonia almost constant)

Negative symptom ( restricted emotional expression or avolition

Not present

Present but mild decrease in facial expressivity,pr osody, gestures or self-iritiated behaviour

Present and moderatede

crease in facial expressivity, prosody, gestures or self-iritiated behaviour

Present and severedecrea se in facial expressivity, prosody, gestures or self-iritiated behaviour

Domain Impaired cognition

0
Not present

1
Equivocal (cognitive function not clearly outside the range expected for age or SE; i. e., within 0,5 SD of mean Equivocal

2
Present but mild (some reduction in cognitive function; below expected for age or SES, 0,5-1 SD of mean) Present but

3
Present and moderate (clearly reduction in cognitive function; below expected for age or SES, 12 SD of mean) Present and

4
Present and severe (severe reduction in cognitive function; below expected for age or SES, >2 SD of mean) Present and

Score

Depression

Not

present

(occasionall y feels sad, down, depressed, or hopeless; concerned about having failed someone or at something but not preoccupied)

Mania

Not present

Equivocal (occational elevated, expansive, or irritable mood or some restlessness)

mild (frequent periods of feels sad, down, moderately depressed, or hopeless; concerned about having failed someone or at something but not preoccupied) Present but mild (frequent periods of somewhat elevated, expansive, or irritable mood or restlessness)

moderate (frequent periods of deep depression, or hopelessness; preoccupation with guilt, having done wrong)

severe (deeply depressed, or hopeless daily; delucional with guilt or unreasonable self-reproach grossly out of proportion to circumtance) Present and severe (daily and extensively elevated, expansive, or irritable mood or restlessness)

Present and moderate (frequent periods of extensively elevated, expansive, or irritable mood or restlessness)